RELATIONSHIP BETWEEN HEPATIC/VISCERAL FAT AND INSULIN RESISTANCE IN NON-DIABETIC AND TYPE 2 DIABETIC SUBJECTS

Abstract

Non alcoholic fatty liver disease (NAFLD) is a chronic inflammatory disease involving a wide range of disorders from simple steatosis, passing to steatohepatitis and ended by fibrosis and cirrhosis , even it may be also passing to hepatocellular carcinoma . Meanwhile, steatosis has been considered a benign disease. Non-alcoholic fatty liver disease (NAFLD) has been often associated with central obesity and insulin resistance and in general with factors of the metabolic syndrome so the aim of this study was to evaluate relationship between hepatic /visceral fat and insulin resistance in non- diabetic and type 2diabetic subjects. The present study included fourty subjects, twenty subjects of them with type 2 diabetes , twenty nondiabetic subjects . All patients were subjected to history taking , physical examination , BMI, waist circumference,laboratory investigations including (TG,LVLDL,LDL,HDL, Total cholesterol,Albumin ,PT, ALT , AST , Total bilirubin , HCV Ab and HB core Ab, Fasting plasma glucose, fasting plasma insulin(ELISA) ) . Homeostatic model assesment for insulin resistance=)fasting glucose(mmol/l) ×fasting insulin(μIU/ml) (/22.5. Radiological investigation (Abdominal sonography to diagnose fatty liver and computerised tomography CT scan without contrast for measurement of hepatic /visceral fat). Results were statisticaly analysed. In our study, HOMA-IR cut-off value of > 2 was used to classify patients as insulin resistance. Patients with HOMA-IR≤ 2 were defined as non-insulin resistance . In this study we aimed at evaluating relationship between hepatic /visceral fat and insulin resistance in ‎non-diabetic and type 2diabetic subjects .In order to achieve this goal we collected ‎ 40 subjects. they was divided into group I : 20 type 2 diabetic subejects(non-insulin resistanc subgroup (HOMA-IR≤2) N=5 -3male and 2 female- age mean±SD 39.65 ± 6.31years and BMI mean±SD29.30 ± 2.00 and Insulin resistance subgroup (HOMA-IR>2) N=15 -7male and 8 female- age mean±SD 45.50±6.76years and BMI mean±SD34.50±2.06 ) and group II: 20 non-diabetic subjects (Non-insulin resistance subgroup(HOMA-IR≤2) N=7 -4male and 3 female- age mean±SD 40.65 ± 6.41years and BMI mean±SD30.50 ± 1.00 and Insulin resistance subgroup (HOMA-IR>2) N=13 –6 male and 7 female- age mean±SD 42.65 ± 6.51years and BMI mean±SD32.70 ± 2.13). We found that abdominal fat (hepatic/visceral fat) significantly correlates with insulin resistance in type 2diabetic and non-diabetic subjects with HOMA-IR>2 . The results of visceral fat and liver/spleen ratio cut off value measured by CT scan without cntrast ; therefore can be used for the prediction or diagnosis of insulin resistance in type 2 diabetic and non-diabetic subjects. Visceral fat is more diagnosis of insulin resistance than BMI in both type 2 diabetic and non-diabetic groups. In our study showed that HOMA-IR had a strong correlation BMI and waist circumference in insulin resistant type 2 diabetic subgroup, thus obesity is associated with insulin resistance in the patients of type 2 diabetes mellitus. In our study showed that Increasing ultrasonographic grades of NAFLD were significantly related with increasing HOMA-IR index, waist circumference, BMI, triglyceride, serum total cholesterol , LDL, VLDL and decreased HDL. In our study showed that cutoff value of liver/spleen ratio (LSR ≤ 1.1=fatty liver)= 0.8‎‎ is the best as a marker of the prediction of insulin resistance in type 2 diabetic group with ‎sensitivity of 55% ,specificity of 65% , PPV of 61.1% , ‎NPV of 66.7% and accuracy of 77.00%.